<%-- 
    Document   : CustAccountRegistration
    Created on : Sep 28, 2011, 10:40:36 AM
    Author     : Belinda
--%>

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        <title>Customer Account Registration</title>
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    <body>
        <div class="container_12">
            <!-- Header Nav -->
            <div class="grid_3"><img src="../TransactWeb/img/reservation/foodsglogo.png" width="146" height="178" /></div>
            <div class="grid_9 nav"><table width="600" border="0">
                    <tr>
                        <td width="89"><a href="index">Home</a></td>
                        <td width="104"><a href="CustAccountRegistration">Register</a></td>
                        <td width="125">Contact Us</td>
                        <td width="76">FAQ</td>
                        <td width="172">Login</td>

                    </tr>
                </table>
            </div>

            <div class="grid_12">
                <hr size="3" color="#CC6600" />
            </div>
            <!-- Welcome Message -->
            <!--<div class="grid_12 welcome">Welcome User!</div>-->
            <!-- End Welcome Message-->

            <!-- End of Header Nav -->
            <!-- Content -->
            <div class="grid_8 push_3 content">
                <!--Register -->

                <table width="600" border="0">
                    <tr>
                        <td class="content_title">Register For An Account</td>
                    </tr>
                </table>

                <br /><br />

                <form id="custAccForm" name="custAccForm" action="CustAccountRegistrationConfirm" method="POST">
                    <table width="600" class="form">
                        <tr>
                            <td>NRIC / Passport No.:</td>
                            <td width="404"><input type="text" name="NRIC" id="NRIC" /></td>
                        </tr>
                        <tr>
                            <td>First Name:</td>
                            <td><input type="text" name="firstName" id="firstName" /></td>
                        </tr>
                        <tr>
                            <td>Last Name:</td>
                            <td><input type="text" name="lastName" id="lastName" /></td>
                        </tr>
                        <tr>
                            <td>Gender : </td>
                            <td><label for="sex"></label>
                                <select name="sex" id="sex">
                                    <option selected="selected">Select Gender</option>
                                    <option>Male</option>
                                    <option>Female</option>
                                </select></td>
                        </tr>
                        <tr>
                            <td width="184">Date of Birth:</td>
                            <td><select id="day" name="day">
                                    <option value="">Day</option>
                                    <option value="01">1</option>
                                    <option value="02">2</option>
                                    <option value="03">3</option>
                                    <option value="04">4</option>
                                    <option value="05">5</option>
                                    <option value="06">6</option>
                                    <option value="07">7</option>
                                    <option value="08">8</option>
                                    <option value="09">9</option>
                                    <option value="10">10</option>
                                    <option value="11">11</option>
                                    <option value="12">12</option>
                                    <option value="13">13</option>
                                    <option value="14">14</option>
                                    <option value="15">15</option>
                                    <option value="16">16</option>
                                    <option value="17">17</option>
                                    <option value="18">18</option>
                                    <option value="19">19</option>
                                    <option value="20">20</option>
                                    <option value="21">21</option>
                                    <option value="22">22</option>
                                    <option value="23">23</option>
                                    <option value="24">24</option>
                                    <option value="25">25</option>
                                    <option value="26">26</option>
                                    <option value="27">27</option>
                                    <option value="28">28</option>
                                    <option value="29">29</option>
                                    <option value="30">30</option>
                                    <option value="31">31</option>
                                </select>
                                <select id="month" name="month">
                                    <option value="">Month</option>
                                    <option value="01">January</option>
                                    <option value="02">February</option>
                                    <option value="03">March</option>
                                    <option value="04">April</option>
                                    <option value="05">May</option>
                                    <option value="06">June</option>
                                    <option value="07">July</option>
                                    <option value="08">August</option>
                                    <option value="09">September</option>
                                    <option value="10">October</option>
                                    <option value="11">November</option>
                                    <option value="12">December</option>
                                </select>
                                <select id="year" name="year">
                                    <option value="">Year</option>
                                    <option value="2010">2010</option>
                                    <option value="2009">2009</option>
                                    <option value="2008">2008</option>
                                    <option value="2007">2007</option>
                                    <option value="2006">2006</option>
                                    <option value="2005">2005</option>
                                    <option value="2004">2004</option>
                                    <option value="2003">2003</option>
                                    <option value="2002">2002</option>
                                    <option value="2001">2001</option>
                                    <option value="2000">2000</option>
                                    <option value="1999">1999</option>
                                    <option value="1998">1998</option>
                                    <option value="1997">1997</option>
                                    <option value="1996">1996</option>
                                    <option value="1995">1995</option>
                                    <option value="1994">1994</option>
                                    <option value="1993">1993</option>
                                    <option value="1992">1992</option>
                                    <option value="1991">1991</option>
                                    <option value="1990">1990</option>
                                    <option value="1989">1989</option>
                                    <option value="1988">1988</option>
                                    <option value="1987">1987</option>
                                    <option value="1986">1986</option>
                                    <option value="1985">1985</option>
                                    <option value="1984">1984</option>
                                    <option value="1983">1983</option>
                                    <option value="1982">1982</option>
                                    <option value="1981">1981</option>
                                    <option value="1980">1980</option>
                                    <option value="1979">1979</option>
                                    <option value="1978">1978</option>
                                    <option value="1977">1977</option>
                                    <option value="1976">1976</option>
                                    <option value="1975">1975</option>
                                    <option value="1974">1974</option>
                                    <option value="1973">1973</option>
                                    <option value="1972">1972</option>
                                    <option value="1971">1971</option>
                                    <option value="1970">1970</option>
                                    <option value="1969">1969</option>
                                    <option value="1968">1968</option>
                                    <option value="1967">1967</option>
                                    <option value="1966">1966</option>
                                    <option value="1965">1965</option>
                                    <option value="1964">1964</option>
                                    <option value="1963">1963</option>
                                    <option value="1962">1962</option>
                                    <option value="1961">1961</option>
                                    <option value="1960">1960</option>
                                    <option value="1959">1959</option>
                                    <option value="1958">1958</option>
                                    <option value="1957">1957</option>
                                    <option value="1956">1956</option>
                                    <option value="1955">1955</option>
                                    <option value="1954">1954</option>
                                    <option value="1953">1953</option>
                                    <option value="1952">1952</option>
                                    <option value="1951">1951</option>
                                    <option value="1950">1950</option>
                                    <option value="1949">1949</option>
                                    <option value="1948">1948</option>
                                    <option value="1947">1947</option>
                                    <option value="1946">1946</option>
                                    <option value="1945">1945</option>
                                    <option value="1944">1944</option>
                                    <option value="1943">1943</option>
                                    <option value="1942">1942</option>
                                    <option value="1941">1941</option>
                                    <option value="1940">1940</option>
                                    <option value="1939">1939</option>
                                    <option value="1938">1938</option>
                                    <option value="1937">1937</option>
                                    <option value="1936">1936</option>
                                    <option value="1935">1935</option>
                                    <option value="1934">1934</option>
                                    <option value="1933">1933</option>
                                    <option value="1932">1932</option>
                                    <option value="1931">1931</option>
                                    <option value="1930">1930</option>
                                    <option value="1929">1929</option>
                                    <option value="1928">1928</option>
                                    <option value="1927">1927</option>
                                    <option value="1926">1926</option>
                                    <option value="1925">1925</option>
                                    <option value="1924">1924</option>
                                    <option value="1923">1923</option>
                                    <option value="1922">1922</option>
                                    <option value="1921">1921</option>
                                    <option value="1920">1920</option>
                                    <option value="1919">1919</option>
                                    <option value="1918">1918</option>
                                    <option value="1917">1917</option>
                                    <option value="1916">1916</option>
                                    <option value="1915">1915</option>
                                    <option value="1914">1914</option>
                                    <option value="1913">1913</option>
                                    <option value="1912">1912</option>
                                    <option value="1911">1911</option>
                                    <option value="1910">1910</option>
                                    <option value="1909">1909</option>
                                    <option value="1908">1908</option>
                                    <option value="1907">1907</option>
                                    <option value="1906">1906</option>
                                    <option value="1905">1905</option>
                                    <option value="1904">1904</option>
                                    <option value="1903">1903</option>
                                    <option value="1902">1902</option>
                                    <option value="1901">1901</option>
                                    <option value="1900">1900</option>
                                </select>
                            </td>
                        </tr>
                        <tr>
                            <td width="184">Phone number:</td>
                            <td>+
                                <input size="4" type="text" id="countryCode" name="countryCode" />
                                -
                                <input size="12" type="text" id="phone" name="phone" /></td>
                        </tr>
                        <tr>
                            <td width="184">Email address:</td>
                            <td><input type="text" id="email1" name="email1" /></td>
                        </tr>
                        <td>Country of origin:</td>
                        <td><select id="country" name="country">
                                <option value=""   >Select One</option>
                                <option value="Afghanistan"   >Afghanistan</option>
                                <option value="Aland Islands"   >Aland Islands</option>
                                <option value="Albania"   >Albania</option>
                                <option value="Algeria"   >Algeria</option>
                                <option value="American Samoa"   >American Samoa</option>
                                <option value="Andorra"   >Andorra</option>
                                <option value="Angola"   >Angola</option>
                                <option value="Anguilla"   >Anguilla</option>
                                <option value="Antarctica"   >Antarctica</option>
                                <option value="Antigua and Barbuda"   >Antigua and Barbuda</option>
                                <option value="Argentina"   >Argentina</option>
                                <option value="Armenia"   >Armenia</option>
                                <option value="Aruba"   >Aruba</option>
                                <option value="Australia"   >Australia</option>
                                <option value="Austria"   >Austria</option>
                                <option value="Azerbaijan"   >Azerbaijan</option>
                                <option value="Bahamas"   >Bahamas</option>
                                <option value="Bahrain"   >Bahrain</option>
                                <option value="Bangladesh"   >Bangladesh</option>
                                <option value="Barbados"   >Barbados</option>
                                <option value="Belarus"   >Belarus</option>
                                <option value="Belgium"   >Belgium</option>
                                <option value="Belize"   >Belize</option>
                                <option value="Benin"   >Benin</option>
                                <option value="Bermuda"   >Bermuda</option>
                                <option value="Bhutan"   >Bhutan</option>
                                <option value="Bolivia"   >Bolivia</option>
                                <option value="Bosnia and Herzegovina"   >Bosnia and Herzegovina</option>
                                <option value="Botswana"   >Botswana</option>
                                <option value="Bouvet Island"   >Bouvet Island</option>
                                <option value="Brazil"   >Brazil</option>
                                <option value="British Indian Ocean Territory"   >British Indian Ocean Territory</option>
                                <option value="British Virgin Islands"   >British Virgin Islands</option>
                                <option value="Brunei"   >Brunei</option>
                                <option value="Bulgaria"   >Bulgaria</option>
                                <option value="Burkina Faso"   >Burkina Faso</option>
                                <option value="Burundi"   >Burundi</option>
                                <option value="Cambodia"   >Cambodia</option>
                                <option value="Cameroon"   >Cameroon</option>
                                <option value="Canada"   >Canada</option>
                                <option value="Cape Verde"   >Cape Verde</option>
                                <option value="Cayman Islands"   >Cayman Islands</option>
                                <option value="Central African Republic"   >Central African Republic</option>
                                <option value="Chad"   >Chad</option>
                                <option value="Chile"   >Chile</option>
                                <option value="China"   >China</option>
                                <option value="Christmas Island"   >Christmas Island</option>
                                <option value="Cocos (Keeling) Islands"   >Cocos (Keeling) Islands</option>
                                <option value="Colombia"   >Colombia</option>
                                <option value="Comoros"   >Comoros</option>
                                <option value="Congo"   >Congo</option>
                                <option value="Cook Islands"   >Cook Islands</option>
                                <option value="Costa Rica"   >Costa Rica</option>
                                <option value="Croatia"   >Croatia</option>
                                <option value="Cuba"   >Cuba</option>
                                <option value="Cyprus"   >Cyprus</option>
                                <option value="Czech Republic"   >Czech Republic</option>
                                <option value="Democratic Republic of Congo"   >Democratic Republic of Congo</option>
                                <option value="Denmark"   >Denmark</option>
                                <option value="Disputed Territory"   >Disputed Territory</option>
                                <option value="Djibouti"   >Djibouti</option>
                                <option value="Dominica"   >Dominica</option>
                                <option value="Dominican Republic"   >Dominican Republic</option>
                                <option value="East Timor"   >East Timor</option>
                                <option value="Ecuador"   >Ecuador</option>
                                <option value="Egypt"   >Egypt</option>
                                <option value="El Salvador"   >El Salvador</option>
                                <option value="Equatorial Guinea"   >Equatorial Guinea</option>
                                <option value="Eritrea"   >Eritrea</option>
                                <option value="Estonia"   >Estonia</option>
                                <option value="Ethiopia"   >Ethiopia</option>
                                <option value="Falkland Islands"   >Falkland Islands</option>
                                <option value="Faroe Islands"   >Faroe Islands</option>
                                <option value="Federated States of Micronesia"   >Federated States of Micronesia</option>
                                <option value="Fiji"   >Fiji</option>
                                <option value="Finland"   >Finland</option>
                                <option value="France"   >France</option>
                                <option value="French Guyana"   >French Guyana</option>
                                <option value="French Polynesia"   >French Polynesia</option>
                                <option value="French Southern Territories"   >French Southern Territories</option>
                                <option value="Gabon"   >Gabon</option>
                                <option value="Gambia"   >Gambia</option>
                                <option value="Georgia"   >Georgia</option>
                                <option value="Germany"   >Germany</option>
                                <option value="Ghana"   >Ghana</option>
                                <option value="Gibraltar"   >Gibraltar</option>
                                <option value="Greece"   >Greece</option>
                                <option value="Greenland"   >Greenland</option>
                                <option value="Grenada"   >Grenada</option>
                                <option value="Guadeloupe"   >Guadeloupe</option>
                                <option value="Guam"   >Guam</option>
                                <option value="Guatemala"   >Guatemala</option>
                                <option value="Guinea-Bissau"   >Guinea-Bissau</option>
                                <option value="Guyana"   >Guyana</option>
                                <option value="Haiti"   >Haiti</option>
                                <option value="Heard Island and Mcdonald Islands"   >Heard Island and Mcdonald Islands</option>
                                <option value="Honduras"   >Honduras</option>
                                <option value="Hong Kong"   >Hong Kong</option>
                                <option value="Hungary"   >Hungary</option>
                                <option value="Iceland"   >Iceland</option>
                                <option value="India"   >India</option>
                                <option value="Indonesia"   >Indonesia</option>
                                <option value="Iran"   >Iran</option>
                                <option value="Iraq"   >Iraq</option>
                                <option value="Iraq-Saudi Arabia Neutral Zone"   >Iraq-Saudi Arabia Neutral Zone</option>
                                <option value="Ireland"   >Ireland</option>
                                <option value="Israel"   >Israel</option>
                                <option value="Italy"   >Italy</option>
                                <option value="Ivory Coast"   >Ivory Coast</option>
                                <option value="Jamaica"   >Jamaica</option>
                                <option value="Japan"   >Japan</option>
                                <option value="Jordan"   >Jordan</option>
                                <option value="Kazakhstan"   >Kazakhstan</option>
                                <option value="Kenya"   >Kenya</option>
                                <option value="Kiribati"   >Kiribati</option>
                                <option value="Kuwait"   >Kuwait</option>
                                <option value="Kyrgyzstan"   >Kyrgyzstan</option>
                                <option value="Laos"   >Laos</option>
                                <option value="Latvia"   >Latvia</option>
                                <option value="Lebanon"   >Lebanon</option>
                                <option value="Lesotho"   >Lesotho</option>
                                <option value="Liberia"   >Liberia</option>
                                <option value="Libya"   >Libya</option>
                                <option value="Liechtenstein"   >Liechtenstein</option>
                                <option value="Lithuania"   >Lithuania</option>
                                <option value="Luxembourg"   >Luxembourg</option>
                                <option value="Macau"   >Macau</option>
                                <option value="Macedonia"   >Macedonia</option>
                                <option value="Madagascar"   >Madagascar</option>
                                <option value="Malawi"   >Malawi</option>
                                <option value="Malaysia"   >Malaysia</option>
                                <option value="Maldives"   >Maldives</option>
                                <option value="Mali"   >Mali</option>
                                <option value="Malta"   >Malta</option>
                                <option value="Marshall Islands"   >Marshall Islands</option>
                                <option value="Martinique"   >Martinique</option>
                                <option value="Mauritania"   >Mauritania</option>
                                <option value="Mauritius"   >Mauritius</option>
                                <option value="Mayotte"   >Mayotte</option>
                                <option value="Mexico"   >Mexico</option>
                                <option value="Moldova"   >Moldova</option>
                                <option value="Monaco"   >Monaco</option>
                                <option value="Mongolia"   >Mongolia</option>
                                <option value="Montserrat"   >Montserrat</option>
                                <option value="Morocco"   >Morocco</option>
                                <option value="Mozambique"   >Mozambique</option>
                                <option value="Myanmar"   >Myanmar</option>
                                <option value="Namibia"   >Namibia</option>
                                <option value="Nauru"   >Nauru</option>
                                <option value="Nepal"   >Nepal</option>
                                <option value="Netherlands"   >Netherlands</option>
                                <option value="Netherlands Antilles"   >Netherlands Antilles</option>
                                <option value="New Caledonia"   >New Caledonia</option>
                                <option value="New Zealand"   >New Zealand</option>
                                <option value="Nicaragua"   >Nicaragua</option>
                                <option value="Niger"   >Niger</option>
                                <option value="Nigeria"   >Nigeria</option>
                                <option value="Niue"   >Niue</option>
                                <option value="Norfolk Island"   >Norfolk Island</option>
                                <option value="North Korea"   >North Korea</option>
                                <option value="Northern Mariana Islands"   >Northern Mariana Islands</option>
                                <option value="Norway"   >Norway</option>
                                <option value="Oman"   >Oman</option>
                                <option value="Pakistan"   >Pakistan</option>
                                <option value="Palau"   >Palau</option>
                                <option value="Palestinian Territories"   >Palestinian Territories</option>
                                <option value="Panama"   >Panama</option>
                                <option value="Papua New Guinea"   >Papua New Guinea</option>
                                <option value="Paraguay"   >Paraguay</option>
                                <option value="Peru"   >Peru</option>
                                <option value="Philippines"   >Philippines</option>
                                <option value="Pitcairn Islands"   >Pitcairn Islands</option>
                                <option value="Poland"   >Poland</option>
                                <option value="Portugal"   >Portugal</option>
                                <option value="Puerto Rico"   >Puerto Rico</option>
                                <option value="Qatar"   >Qatar</option>
                                <option value="Reunion"   >Reunion</option>
                                <option value="Romania"   >Romania</option>
                                <option value="Russia"   >Russia</option>
                                <option value="Rwanda"   >Rwanda</option>
                                <option value="Saint Helena and Dependencies"   >Saint Helena and Dependencies</option>
                                <option value="Saint Kitts and Nevis"   >Saint Kitts and Nevis</option>
                                <option value="Saint Lucia"   >Saint Lucia</option>
                                <option value="Saint Pierre and Miquelon"   >Saint Pierre and Miquelon</option>
                                <option value="Saint Vincent and the Grenadines"   >Saint Vincent and the Grenadines</option>
                                <option value="Samoa"   >Samoa</option>
                                <option value="San Marino"   >San Marino</option>
                                <option value="Sao Tome and Principe"   >Sao Tome and Principe</option>
                                <option value="Saudi Arabia"   >Saudi Arabia</option>
                                <option value="Senegal"   >Senegal</option>
                                <option value="Seychelles"   >Seychelles</option>
                                <option value="Sierra Leone"   >Sierra Leone</option>
                                <option value="Singapore"   >Singapore</option>
                                <option value="Slovakia"   >Slovakia</option>
                                <option value="Slovenia"   >Slovenia</option>
                                <option value="Solomon Islands"   >Solomon Islands</option>
                                <option value="Somalia"   >Somalia</option>
                                <option value="South Africa"   >South Africa</option>
                                <option value="South Georgia and South Sandwich Islands"   >South Georgia and South Sandwich Islands</option>
                                <option value="South Korea"   >South Korea</option>
                                <option value="Spain"   >Spain</option>
                                <option value="Spratly Islands"   >Spratly Islands</option>
                                <option value="Sri Lanka"   >Sri Lanka</option>
                                <option value="Sudan"   >Sudan</option>
                                <option value="Suriname"   >Suriname</option>
                                <option value="Svalbard and Jan Mayen"   >Svalbard and Jan Mayen</option>
                                <option value="Swaziland"   >Swaziland</option>
                                <option value="Sweden"   >Sweden</option>
                                <option value="Switzerland"   >Switzerland</option>
                                <option value="Syria"   >Syria</option>
                                <option value="Taiwan"   >Taiwan</option>
                                <option value="Tajikistan"   >Tajikistan</option>
                                <option value="Tanzania"   >Tanzania</option>
                                <option value="Thailand"   >Thailand</option>
                                <option value="Togo"   >Togo</option>
                                <option value="Tokelau"   >Tokelau</option>
                                <option value="Tonga"   >Tonga</option>
                                <option value="Trinidad and Tobago"   >Trinidad and Tobago</option>
                                <option value="Tunisia"   >Tunisia</option>
                                <option value="Turkey"   >Turkey</option>
                                <option value="Turkmenistan"   >Turkmenistan</option>
                                <option value="Turks And Caicos Islands"   >Turks And Caicos Islands</option>
                                <option value="Tuvalu"   >Tuvalu</option>
                                <option value="Uganda"   >Uganda</option>
                                <option value="Ukraine"   >Ukraine</option>
                                <option value="United Arab Emirates"   >United Arab Emirates</option>
                                <option value="United Kingdom"   >United Kingdom</option>
                                <option value="United States"   >United States</option>
                                <option value="United States Minor Outlying Islands"   >United States Minor Outlying Islands</option>
                                <option value="Uruguay"   >Uruguay</option>
                                <option value="US Virgin Islands"   >US Virgin Islands</option>
                                <option value="Uzbekistan"   >Uzbekistan</option>
                                <option value="Vanuatu"   >Vanuatu</option>
                                <option value="Vatican City"   >Vatican City</option>
                                <option value="Venezuela"   >Venezuela</option>
                                <option value="Vietnam"   >Vietnam</option>
                                <option value="Wallis and Futuna"   >Wallis and Futuna</option>
                                <option value="Western Sahara"   >Western Sahara</option>
                                <option value="Yemen"   >Yemen</option>
                                <option value="Zambia"   >Zambia</option>
                                <option value="Zimbabwe"   >Zimbabwe</option>
                                <option value="Serbia"   >Serbia</option>
                                <option value="Montenegro"   >Montenegro</option>
                            </select></td>
                        </tr>
                        <tr>
                            <td>City of origin:</td>
                            <td><input type="text" id="city" name="city" /></td>
                        </tr>
                    </table>
                    <br />
                    <table width="600" class="form">
                        <tr>
                            <td width="187">Username:<br/>
                                (Min.8-Max.15 chars)</td>
                            <td width="401"><input type="text" id="chosenUsername" name="chosenUsername" maxlength="15" /></td>
                        </tr>
                        <tr>
                            <td>Password:<br/>
                                (Min.8-Max.15 chars)</td>
                            <td><input type="password" id="password1" name="password1" maxlength="15" /></td>
                        </tr>
                        <tr>
                            <td>Confirm password:</td>
                            <td><input type="password" id="password2" name="password2" maxlength=15 /></td>
                        </tr>
                    </table>
                    <table width="600" class="form">
                        <tr height="30">
                            <td width="283">Do you agree to the Terms and Conditions?</td>
                            <td width="305"><input type="checkbox" id="terms" name="terms" value="Yes" />
                                Yes</td>
                        </tr>
                        <tr>
                            <td><input name="register" type="submit" value="Register" /></td>
                        </tr>
                    </table>
                </form>
                <!--End Register -->
            </div>
            <!-- End Content -->
            <!-- Footer -->
            <div class="grid_12 footer">
                <hr size="3" color="#CC6600" />
                Copyright FoodSage 2011</div>
            <!-- End Footer-->
        </div>
    </body>
</html>

